【摘要】 目的 观察抗Xa活性联合抗凝血酶测定在脓毒症患者静脉血栓栓塞抗凝治疗中的应用价值。方法 选取2023年1月—2024年10月佛山市第一人民医院收治的脓毒症患者160例，按照随机数字表法分为观察组和对照组，各80例。对照组给予固定剂量依诺肝素40 mg治疗；观察组于用药第1天检测抗凝血酶，并根据抗凝血测定结果补充新鲜冰冻血浆，于第3天检测抗Xa活性并根据结果调整肝素用量。比较2组用药第1、3、7天的活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、凝血酶—抗凝血酶复合物(TAT)水平，用药第3天的抗Xa活性，静脉血栓栓塞和出血并发症发生率。结果 用药第1、3、7天，2组APTT、D-D、TAT水平组间比较差异无统计学意义(P>0.05);用药第3、7天，2组APTT均长于第1天，D-D、TAT水平均低于第1天(P<0.01);用药第3天，观察组与对照组抗Xa活性比较差异无统计意义(P>0.05)。观察组静脉血栓栓塞发生率为0,低于对照组的10.00%(χ~2=6.447,P=0.004);观察组出血并发症发生率为2.50%,低于对照组的12.50%(χ~2=5.776,P=0.016)。结论 脓毒症患者静脉血栓栓塞症抗凝治疗给予抗凝血酶活性检测并在抗凝过程中根据监测抗Xa因子活性调整用药剂量可有效降低下肢静脉血栓发生率及出血风险。更多还原

【Abstract】 Objective To observe the clinical value of anti-Ⅹa activity combined with antithrombin determination in the anticoagulant therapy of venous thromboembolism in patients with sepsis. Methods A total of 160 septic patients admitted to the First People′s Hospital of Foshan between January 2023 and October 2024 were selected and randomly divided into an observation group and a control group using a random number table, with 80 patients in each group.The control group received a fixed dose of 40 mg enoxaparin. In the observation group, antithrombin AT levels were measured on the first day of treatment, and fresh frozen plasma was supplemented based on the AT results. Anti-Ⅹa activity was measured on day 3, and the heparin dosage was adjusted accordingly.The following parameters were compared between the two groups: APTT,D-D and TAT levels on treatment days 1, 3 and 7, anti-Ⅹa activity on day 3, as well as the incidence of venous thromboembolism and bleeding complications. Results No statistically significant differences were observed in APTT, D-D and TAT levels between the two groups on treatment days 1, 3 and 7(P>0.05). On days 3 and 7, the APTT levels in both groups were significantly longer than those on day 1, while D-D and TAT levels were significantly lower than those on day 1(P<0.01). At day 3, the difference in anti-Ⅹa activity between the observation and control groups was not statistically significant(P>0.05).The incidence of venous thromboembolism was 0 in the observation group, which was significantly lower than the 10.00% in the control group(χ~2=6.447, P=0.004). The incidence of bleeding complications was 2.50% in the observation group, also significantly lower than the 12.50% in the control group(χ~2=5.776, P=0.016). Conclusion In septic patients receiving anticoagulant therapy for venous thromboembolism, a regimen guided by antithrombin activity testing and tailored based on monitoring of anti-Ⅹa activity can effectively reduce the incidence of lower-extremity deep vein thrombosis and the risk of bleeding.更多还原